What Have California Doctors Learned About Cannabis?

October 23rd, 2006 – An Interview with Jeffrey Hergenrather, MD
It has been 10 years since California voters enacted Proposition 215, making it legal to grow and use cannabis, with a doctor’s approval, for medical purposes. Prop 215 didn’t create a record-keeping system because the authors didn’t trust the government and didn’t want to generate a master list of cannabis users. So, over the course of the past decade, a vast public health experiment has been conducted in California but no state agency has been tracking doctors who approve cannabis use or patients who medicate with it.

To assess the results in the absence of government-garnered data, I surveyed doctors associated with the Society of Cannabis Clinicians. The SCC was founded by Tod Mikuriya, MD, in 2000 so that doctors monitoring their patients’ use of cannabis could share data for research purposes (and, alas, respond to threats from federal and state authorities). More than 20 doctors have attended SCC meetings, which are held quarterly. Philip A. Denney, MD, is the current president.

Some responses to the survey have not yet been received, but it appears that the specialists have approved cannabis use by more than 140,000 patients. “Approve,” not “recommend,” is the apt term, since more than 95 percent of the patients consulting specialists had been self-medicating previously.

The specialists account for approximately 40% of the letters of authorization on file with an agency that issues ID cards on behalf of cannabis dispensaries (to spare them having to confirm the validity of each customer’s letter of approval). Extrapolating from this ratio, I estimate the number of Californians who have used and/or provided medicinal cannabis legally under Prop 215 to be about 350,000.

The complete survey will appear in the Fall issue of O’Shaughnessy’s, a journal I produce for the SCC. What follows are excerpts from the response of Jeffrey Hergenrather, MD, a former family practitioner who has been conducting cannabis consultations in Sebastopol since 1999.

Q. How many patients will have received your approval to use cannabis through October 2006?

A. 1,430

Q. What percentage had been self-medicating with cannabis prior to consulting you?

A. 99%

Q. With what medical conditions have they presented? List top five and approximate percentage (total can exceed 100%).

Q. What results do patients report? How does cannabis appear to work in treating their symptoms?

A cannabis specialist soon becomes aware of two remarkable facts. The range of conditions that patients are treating successfully with cannabis is extremely wide; and patients get relief with the use of cannabis that they cannot achieve with any other pharmaceuticals.

The testimonies that I hear on a daily basis from people with serious medical conditions are moving and illuminating. From many people with cancer and AIDS come reports that cannabis has saved their lives by giving them an appetite, the ability to keep down their medications, and mental ease. No other drug works like cannabis to reduce or eliminate pain without significant adverse effects. It evidently works on parts of the brain involving short-term memory and pain centers, enabling the patient to stop dwelling on pain. Cannabis helps with muscle relaxation, and it has an anti-inflammatory action. Patients with rheumatoid arthritis stabilize with fewer and less destructive flare-ups with the regular use of cannabis.

Other rheumatic diseases similarly show remissions. Spasticity cannot be treated any more quickly or efficiently than with cannabis, and, again, without significant adverse effects.

Patients who suffer from migraines can reduce or omit conventional medications as their headaches become less frequent and less severe.

About half of the patients with mood disorders find that they are adequately treated with cannabis alone while others reduce their need for other pharmaceuticals. In my opinion, there is no better drug for the treatment of anxiety disorders, brain trauma and post concussion syndrome, ADD and ADHD, obsessive compulsive disorder, and post-traumatic stress disorder. Patients with Crohn’s disease and ulcerative colitis are stabilized, usually with comfort and weight gain, while most are able to avoid use of steroids and other potent immunomodulator drugs.

People who were formerly dependent on alcohol, opiates, amphetamines and other addictive drugs have had their lives changed when substituting with cannabis. Patients with end-stage renal disease on dialysis and those with transplanted kidneys show mental ease, comfort, and lack of significant graft-versus-host incompatibility reactions in my small series.

Sleep patterns are typically improved, with longer and deeper sleep without any hangover or significant adverse effects.

Many patients with multiple sclerosis report that their condition has not worsened for many years while they have been using cannabis regularly. MS and other neurodegenerative diseases share the common benefits of reduced pain and muscle spasms, improved appetite, improved mood and fewer incontinence problems. Many patients with epilepsy are adequately treated with or without the use of other anticonvulsants.

Patients with skin conditions associated with systemic disease such as psoriasis, lupus, dermatitis herpetiformis, and eczema all report easement and less itching when using cannabis regularly.

Airway diseases such as asthma, sleep apnea, COPD, and chronic sinusitis deserve special mention because I encourage the use of cannabis vapor or ingested forms rather than smoking to reduce airway irritation. Finally, most obese and morbidly obese patients respond with weight loss and improved self esteem. I believe that cannabis and psychotherapy work well together in fostering behavioral changes.

Q. Have you compiled demographic data or can you estimate the breakdown with respect to your patients’ age, gender, race, economic status?

Gender: 62% male, 38% female. Ages range from 14 to 86 years old. The male mean age is 45.9 years with a median age of 46. The female mean age is 47.4 with a median age of 48 years. The graphs of the age and gender distribution are similar with the exception that there is a bump in the leading edge of my male patient population as compared to the females, which I account for by young men’s work injuries, sports injuries, motor vehicle accidents, and problems stemming from military service, including injuries and post-traumatic stress disorder. The vast majority of patients in my practice are of Caucasian / Indo-European descent, with only about 1% African-American, 2% Native American, 1% Pacific Islanders, and 2% Asian.

Q. Have you observed or had reports of adverse effects from cannabis? If so, please describe.

Is there a downside to the use of cannabis? The sense of intoxication rarely lasts longer than an hour and tends to be more troubling to the novice than to the experienced user. For some people cannabis can induce dry mouth, red eyes, unsteady gait, mild in-coordination, and short-term memory loss, all of which are transient. These effects are reportedly trivial compared to those brought on by pharmaceutical alternatives.

Cannabis use is steadily finding acceptance in society. Still, for many it remains awkward if not totally impractical in the workplace. People whose jobs require multi-tasking such as pilots, drivers, dispatchers, switchboard operators, and many professionals find the intoxicating effects of cannabis inappropriate in the workplace, and therefore reserve their use for after work. Strains

Q. What have you learned re strains and dosage?

Cannabis is a complex, un-patentable plant with vast pharmacologic potential. Different strains contain different mixes of cannabinoids and terpenes that give them distinct qualities. Some strains energize you; others put you to sleep. Many patients, when they find a strain that suits their needs, try to obtain it on a regular basis. Unless they are growing their own from cuttings, however, they have to rely on growers and distributors to reproduce and make available the preferred strain from year to year.

Due to Prohibition, California growers have been denied the tools of analytical chemistry to test the cannabinoid contents of their plants. This has impeded the development of strains aimed at treating various conditions. Nevertheless, patients continue to educate themselves about cannabis as medicine and how best to use it. Over the years that I have specialized in cannabis therapeutics, health benefits reported by patients have been substantiated and explained by findings from research centers around the world.

Vaya Con Dios

The great Freddy Fender died last week -lung cancer at age 69. From his Associated Press obit: “his career was put on hold [in 1960] when he and his bass player ended up spending almost three years in prison in Angola, LA., for marijuana possession.” He was born Baldemar Huerta and took the name Fender in honor of his electric guitar when he signed with Imperial Records in 1959. He took “Freddy” because he thought it sounded good with Fender. I never stopped giving my vinyl “Best of Freddy Fender” a spin.

Look at how America treats its artists, its national treasures! Clifford Antone, founder of Austin’s famous blues club, died in May of this year. He served two prison terms, according to his obit in the New York Times, “one in the 1980’s for possessing marijuana and another from 2000 to 2002 for dealing more than 9,000 pounds of the drug and laundering money Mr. Antone was known for his generosity to musicians. He organized a series of benefits for victims of Hurricane Katrina and recently he helped arrange an apartment and nursing care for the 92-year-old pianist Pinetop Perkins.”

Paul Armentano of NORML has analyzed a new U.S. Department of Justice report for 2004 and concludes that U.S. taxpayers are now spending more than a billion dollars annually to incarcerate citizens for pot. Armentano estimates that 33,655 state inmates and 10,785 federal inmates are locked up on marijuana charges. The DOJ report didn’t provide stats for county jails.

Thousands behind bars cannot see the stars
Shining o’er the land of the free
They could be at home if they could grow their own
Or get it from the local pharmacy.